BAD MEDICINE

Doctors as Doormats in the David Petraeus Scandal

As the David Petraeus scandal unfolds, physicians everywhere are wondering: why are the suckers in this story both doctors? Internist Kent Sepkowitz on the truth about love lives in lab coats.

With all our recent excitement in discovering just how horny generals, West Pointers, and unpaid social liaisons seem to be, a very basic important and altogether alarming aspect of the All In affair has been overlooked. It’s something that threatens to cripple health care nationwide and cast even longer shadows in the already dim hallways of American hospitals everywhere.

Granted, the exact carnal details are not yet sorted out, but physicians everywhere are crying out in unison: why oh why are the cuckold and maybe-not-a-cuckold-the-story-isn’t-confirmed both practicing doctors? (And both named Scott?)

Is there something, er, deficient about the type of guy who earns a living saving lives, succoring the sick, abetting the needy? I mean we have so many TV shows about us and we earn a nice living! People used to like us, really like us. What happened? Is it that we are too busy looking at X-rays, taking out gall bladders, returning phone calls late into the night? Do we just lack the necessities? Are we that inferior to a guy in a stiff wool uniform? Maybe our long white coat is too familiar and unadorned and butcherlike to garner respect anymore—and the man with bars and epaulettes is the new hot thing. Oh, Lieutenant Brody, this is all your fault.

The key to understanding this diverting scandal is not to be found in the thousands of emails between David and Paula and John and Jill and Scott and Scott or by designing a conspiracy theory clever enough to incorporate Benghazi and Tampa with women who do pushups on The Daily Show but by considering this one issue: are physicians lousy spouses? Doctors long have worried about this. Indeed, in 1997, a major article in The New England Journal of Medicine examined just how good (or not) M.D. marriages were compared with the rest of the pack. The authors looked at more than 1,000 doctors and found that the rate of divorce overall was more or less the same as other occupations—but varied greatly according to medical specialty (and by anger score; those in the top rage quartile also were at the top in divorce rate. Ah, those grade-grubbing, overachieving doctors). Surprisingly (or extremely unsurprisingly) psychiatrists led the pack at 50 percent, leaving the runners-up (surgeons) in the dust at 33 percent.

Maybe our long white coat is too familiar and unadorned and butcherlike to garner respect anymore—and the man with bars and epaulettes is the new hot thing. Oh, Lieutenant Brody, this is all your fault.

One way to look at the issue is the number of marriages that end in divorce (about half, eventually). Another is to consider the rate of divorce among first-time marrieds, since it may be that people who divorce once are likelier to do it, thereby introducing a skew into the data that even the finest unskewer can’t undo. The New England Journal article looked at divorce within 30 years of marriage; other studies look at the rate at 10 years, or over a lifetime. Oddly, the published literature on occupation-specific divorce rates is quite sparse, making it difficult to compare doctors to other occupations with similar socioeconomic features. One article, however, examined early divorce rates (U.S. rate: 16 percent) across occupations to determine where law-enforcement workers fell in. Doctors here were below average, far behind the big splitters, dancers and choreographers, bartenders, and massage therapists.

So what about surgeons? Scott Broadwell is an extremely qualified cancer surgeon who trained at top-notch places and has a video to prove it. As noted, surgeons in the 1997 study had a divorce rate of 33 percent above the overall rate that included veteran sticks-in-the-mud like pediatricians (22 percent) and internists like me (24 percent). Or Scott Kelly, also well trained as an interventional radiologist (though without a video). The interventional radiologist (IR) practitioner is a slightly uptown version of the standard desk-bound diagnostic radiologist; he doesn’t merely look at X-rays but rather does something—drains abscesses, places catheters, biopsies masses—that makes him a sort of mini-surgeon. The radiology crowd didn’t even make the cut in the 1997 article. But given the attributes of the IR specialist, a profile similar to surgeons would not surprise.

Though tempting to blame the personality of the snooty too-important-for-you doctor in the marital debacle, likely this is not what is underneath the mess. Rather this seems to be yet another tale of ambitious, desperate, rather unattractive people grabbing and lurching toward power and youth and willingness as they have done ever since Abraham laid with his wife’s concubine, Hagar, and gave us Ishmael. The fact that the snooty doctors have been upstaged by the even more preening, self-importing, brisk, über-manly binders full of generals is actually a relief of sorts—finally a profession more detestable than ours! But the joy is brief when we consider the escapade’s casualties not as generals, where pain and loss are always part of the equation, but as doctors who, no matter how annoying, are programmed to try to make people better. Unfortunately for the families shattered by this colossal public ejaculation of desire, right now medicine has little to offer.